目的 探讨常规单纯吻合指动脉与动脉静脉化对比应用末节断指再植的临床疗效.方法 我院2009 年10 月至2012 年4 月收治80 例92 指末节离断行再植患者,其中42 例47 指(对照组)予以常规单纯吻合指动脉方法,另外38 例45 指(观察组)予以掌侧浅动脉静化方法,术后观察并对比两组病例治疗效果和血液循环改善情况,跟踪随访5~14 个月后,总结受试者术后并发症及恢复状况.结果 观察组成活率为97.78% (44/45),伤口一期愈合率为93.33% (42/45),手指灵活度为88.89% (40/45);对照组成活率为74.47% (35/47),伤口一期愈合率为68.09% (32/47),手指灵活度为61.70% (29/47).比较伤口出血量、张力、温度及毛细血管流速等血液循环指标,观察组改善情况明显优于对照组,差异具有统计学意义(P<0.05).随访纪录总结病例断指复发情况,与对照组比较,观察组治愈趋势良好(P<0.05).结论 针对断指损伤程度采用新型指动脉静脉化再植术,可显著提高再植适应性、成活率、愈合率,是解决静脉回流、减少术后并发的有效途径.%Objective To study the clinical curative effect of conventional simple anastomotic digital artery and artery vein change in the replantation of distal revered fingers. Methods Eighty patients with replantation of distal severed fingers (92 fingers) in our hospital from October 2009 to April 2012 were selected as research subjects. The patients were divided into two groups, the control group and the study group. The control group (42 patietns, 47 fingers) was provided with conventional simple anastomotic artery, and the study group (38 patients, 45 fingers) applied artery vein change. After operation, the clinical effect and blood circulation improvement were observed and compared between the two groups. After the follow-up of 5 to 14 months, the postoperative complications and recovery situation were summarized. Results The survival rate, wound healing rate, finger agile degrees in the study group were 97.78% (44/45), 93.33% (42/45), 88.89% (40/45), and 74.47% (35/47), 68.09% (32/47), 61.70% (29/47), respectively. The improvement in blood circulation indexes such as amount of bleeding, tension, temperature and capillary flow velocity in study group was significantly better than that of the control group (P<0.05). The recovery and recurrence status were significantly better in the study group than the control group (P<0.05). Conclusion Taking new artery vein change reimplantation according to the degree of damage to the finger, we can significantly improve the adaptability, survival rate, healing rate of replantation, which is the effective solution for venous return and reducing postoperative concurrent.
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